Gender Specific Differentials of Medical Practice in California

To determine if differences exist in medical practice between male and female physicians, data were obtained from the biennial questionnaire required of all physicians in California in order to maintain their license. Gender data were analyzed in relation to a variety of practice variables. Differentials in medical and surgical specialization, practice settings, hours spent in primary and secondary specialties, primary professional activities, and geographic location were all studied. It was concluded that significant differences were found between male and female physicians in many of the practice variables studied. Implications of findings for the future recruitment of women into medical training programs, the national health personnel or "manpower" scene, and the U.S. health care delivery system are discussed.     

广州市越秀区居民就医意向及选择中医服务影响因素分析

目的 了解广州市越秀区居民就医选择意向及选择中医服务的影响因素.方法 采用问卷调查方式,抽取广州市越秀区15～69岁常住居民2008人,运用SPSS 20.0进行单因素分析和多因素Logistic回归分析.结果 越秀区居民中选择中西医结合、中医、西医和无所谓的比例分别为38.7％、29.6％、22.0％和9.7％.多因素Logistic回归分析显示,家庭月收入较低(OR=1.709、2.227)、个人养生兴趣较大(OR=1.530、2.457)、接受过中医服务(OR=1.565)和中医基础知识水平较高(OR=1.469)者,就医时选择中医服务的比例较高.结论 中医服务已在居民中有相当的接受度,应该在居民中普及正确的中医知识和日常保健常识,提高居民对中医的兴趣.同时,医疗机构应提供多元化的服务,提高中医药服务的利用率.     

The Impact of Gender Roles on Health

The present research focused on a sample of Spanish undergraduate women and men to evaluate whether gender was related to substance use and chronic illness. This research examined the associations of conformity to masculine norms for men and conformity to feminine norms for women with substance use in chronic illnesses. Spanish male (n = 226) and female (n = 234) college undergraduates completed measures of chronic diseases, alcohol and tobacco consumption, and conformity to gender norms. Multivariable regression analyses demonstrated that being female was related to lower alcohol and cigarette consumption but a greater rate of chronic illnesses. Although masculinity did not explain the rate of chronic illnesses, specific feminine and masculine gender norms were related to alcohol and tobacco use and prevalence of chronic diseases. The present study provides insights for further cross-cultural psychological studies on the mediating effect of self-reported conformity to gender norms (rather than only sex) on health. Limitations and implications are discussed.     

An Early Preceptorship and Medical Students' Beliefs, Values, and Career Choices

Background and Objectives: Curriculum influence on career choice is difficult to determine. In this study we explored the impact of a summer rural/underserved preceptorship on the residency choices of participants and on the beliefs and attitudes of participating students about rural underserved primary care practices.Methods: Two data sets are used to examine the Rural/Underserved Opportunities Program (R/UOP). Matriculation and residency selection information is analyzed to compare R/UOP participants with nonparticipants. Second, a survey eliciting beliefs and attitudes about various career choices was given to participants before and after the experience and to a sample of nonparticipating classmates matched for age, race, and ethnicity.Results: At matriculation, R/UOP participants gave higher rankings to primary care specialties as possible career choices. They were more likely to be matched in a primary care residency than nonparticipants. R/UOP participants expressed belief in more differences between urban and rural practice than did nonparticipants. They maintained their higher attitudes towards rural practice.Conclusions: R/UOP supports preexisting beliefs and positive attitudes towards rural underserved primary care careers. Participating students do not have large differences at entry into medical school. They are more likely to select primary care residencies, compared with nonparticipants.This revised version was published online in September 2005 with corrections to the Cover Date.     

性别在避孕方法认识、选择与决定中的作用

目的：了解并分析性别在避孕方法认识、选择与决定中的作用。方法：在四川省内采用分层、整群抽样及结构式问卷方法调查。结果：有效调查已婚育龄男女2631人,男、女对避孕方法的认识较一致;避孕方法使用比例居前3位的依次是宫内节育器（55.8％）、避孕套（24.2％）和男性绝育（5.7％）;选择男／女用避孕方法与调查对象对避孕方法、计划生育责任的认识以及男、女在家庭中的角色有关;避孕选择决定方式与性别因素和夫妻之间的沟通交流有关。结论：男性优势的传统观念仍然根深蒂固,调查人群对男性参与计划生育／生殖健康重要性的认识不足。社会各界需共同努力,促进性别的公平与公正及对妇女的赋权,构建合谐健康的两性关系、家庭和社区环境。     

OB DEPARTMENT: American College Of Obstetricians and Gynecologists: Confusion in Medical Data,Recent Advances in Ob-Gyn Surgery Receive Attention at Meeting

Topics presents more abstracts of selected papers presented at the recent ACOG meeting. The first group appeared in the June issue, pp. 87–91.     

Factors Influencing Nursing Career Choices and Choice of Study Program

In advance of a recruitment campaign, Israeli first-year nursing students of all ethnicities were surveyed to elucidate what factors had influenced them to make nursing their career and what sort of training track they preferred. The responses made it clear that different factors influence different groups differently. There were noticeable differences by gender, age, and ethnicity. Overall, training institutions were chosen for their closeness to the student's home but other factors also operated among particular groups, such as institutional prestige and flexible entry criteria. There was a blatant preference for academic, particularly university-sited, programs over diploma programs.     

Gender,Recovery from Late Life Heart Attack and Medical Care

It has only recently been recognized that there are sigmfkant gender effects on heart disease and that women face increasing risks as they age. A longitudinal study of 246 older myocardial infarction (MI) patients included a 113 sample of women Findings indicate that over the first post-MI year, women had greater risk of death, cardiac distress and reinfarction. Cardiac symptoms of men declined while those of women increased. Several medical care and social disadvaatages were found among the post-MI women, including less aggressive cardiac care. Furthermore, since morbidity and mortality were related to medical care aad social disadvantages, the results support gender-age stratification theories.     

Designated Medical Directors for Emergency Medical Services: Recruitment and Roles

ABSTRACT:  Context: Emergency medical services (EMS) agencies rely on medical oversight to support Emergency Medical Technicians (EMTs) in the provision of prehospital care. Most states require EMS agencies to have a designated medical director (DMD), who typically is responsible for the many activities of medical oversight. Purpose: To assess rural-urban differences in obtaining a DMD and in their responsibilities. Methods: A national survey of 1,425 local EMS directors, conducted in 2007. Findings: Rural EMS directors were more likely than urban ones to report DMD recruitment problems, but recruitment barriers were similar, with the most commonly reported barrier being an unwillingness of local physicians to serve. Rural EMS directors reported that their DMDs were less likely to be trained in Emergency Medicine, and were less likely to provide educational support functions such as continuing education. Rural agencies were more likely to get on-line medical direction from their DMD, but were less likely to always get the on-line support they needed. Common barriers to on-line support were typical of rural communication barriers. Conclusions: Existing recommendations for DMD qualifications may be difficult to attain in rural communities. To develop programs that will support medical direction for rural EMS agencies, it is important to learn what physicians identify as the barriers to serving as DMDs, and whether there are alternative and innovative ways to provide an optimal level of medical oversight. Solutions will likely be multi-faceted, as EMS activities and organizational structures are diverse and the responsibilities of the DMD are broad.     

"娘家人"代言--四川民营医疗机构管委会的多重扮演

身陷夹缝,势单力薄,又缺少“娘家”的民营医院逐渐意识到,同行之间不仅要竞争,而且要合作,要形成团体并以团体的名义去保护同行业的整体利益。这种独立于官商之外的“第三方力量”,终于使民营医院的维权自律不再是“独脚戏”。     

Practice management. Gender offenders

A postal survey of practice managers in London found that women earned 5,000 Pounds a year less than men, on average. Women who had previously worked as receptionists in the practice were particularly poorly paid. Practice management remains a female-dominated profession. Primary care trusts should seek to standardise rates of pay and promote greater equality.     

医疗救助在医疗保障体系中的地位和作用

医疗救助是政府对因患病而无经济能力诊治的贫困人群,实施专项帮助和资金资助的一种医疗保障制度。从保障人群的健康权,促进社会稳定,构建和谐社会,提高医疗服务及医疗保险制度公平性的高度出发,论述了建立与发展医疗救助制度的重要意义;分析了我国实施医疗救助的特点以及医疗救助与基本医疗保险的共同点与区别;阐述了医疗救助在医疗保障体系中的地位和作用。     

略论医学伦理学基本问题与医德作用

为加强党风、政风、行风建设，推进廉政文化建设，切实解决医德滑坡现象，消除收“红包”、拿回扣、乱收费，服务质量差等不规范服务行为，文章试图从医德伦理学基本问题与医德作用两个方面论述加强医疗卫生单位工作人员职业道德教育的重要性。     

Gender Differences in Chronic Medical, Psychiatric, and Substance-Dependence Disorders Among Jail Inmates

Objectives. We investigated whether there were gender differences in chronic medical, psychiatric, and substance-dependence disorders among jail inmates and whether substance dependence mediated any gender differences found.Methods. We analyzed data from a nationally representative survey of 6982 US jail inmates. Weighted estimates of disease prevalence were calculated by gender for chronic medical disorders (cancer, hypertension, diabetes, arthritis, asthma, hepatitis, and cirrhosis), psychiatric disorders (depressive, bipolar, psychotic, posttraumatic stress, anxiety, and personality), and substance-dependence disorders. We conducted logistic regression to examine the relationship between gender and these disorders.Results. Compared with men, women had a significantly higher prevalence of all medical and psychiatric conditions (P ≤ .01 for each) and drug dependence (P < .001), but women had a lower prevalence of alcohol dependence (P < .001). Gender differences persisted after adjustment for sociodemographic factors and substance dependence.Conclusions. Women in jail had a higher burden of chronic medical disorders, psychiatric disorders, and drug dependence than men, including conditions found more commonly in men in the general population. Thus, there is a need for targeted attention to the chronic medical, psychiatric, and drug-treatment needs of women at risk for incarceration, both in jail and after release.Approximately 13 million individuals spent time in a US jail facility during 2007.¹ At midyear, 780 581 individuals were held in a jail.¹ Jails are facilities, generally operated by local city or county governments, that hold individuals before trial or sentencing (adjudication) or individuals serving short sentences.² Despite the explosive growth of the criminal-justice population over the last 30 years,³ the exclusion of inmates from most national health surveys has made it difficult to systematically study the broad range of health conditions that inmates face. Estimates of disease prevalence among inmates in the United States have generally had to rely on data from individual cities or states,⁴ use extrapolations from the general, noninstitutionalized population,⁵ or focus on infectious diseases.^6–8 Even less epidemiological information is available about the health problems of female inmates and gender differences among jail inmates.In the noninstitutionalized, general population, women report worse physical health and a higher prevalence than men of some mental-health disorders, such as depression and anxiety.⁹ Among jail inmates in the United States, a higher proportion of women (53%) than men (35%) report a current medical problem.¹⁰ In correctional facilities in New South Wales, Australia, a survey of inmates found that 81% of women and 65% of men had at least 1 chronic health condition.¹¹ In a nonrandom sample of individuals being released from a New York City jail, women reported a higher prevalence of depression, anxiety, and asthma than men, and women were more likely to have visited an emergency room or have had a hospital admission than men.¹² However, gender differences reported in these previous studies did not account for age, race, and education as possible confounders.Many women in jail have a history of sexual and physical abuse,¹³ psychiatric disorders,^14,15 psychological distress,^16,17 and substance dependence,^18,19 conditions that can complicate the recognition of and provision of medical care for other chronic medical conditions. For instance, drug dependence can complicate the management of chronic medical conditions in the community (e.g., hypertension) because of competing needs for drug treatment, housing, employment, and income, and because of mistrust between drug users and medical providers. Drug and alcohol dependence, common in jail inmates,¹⁸ also causes health problems, either directly via the toxic effects of the substance (e.g., overdose, alcoholic hepatitis) or indirectly via use practices (e.g., sharing syringes, which can cause blood-borne infections). Therefore, in jail inmates, substance dependence should be considered when assessing gender differences in other chronic medical and psychiatric conditions.The complexity of conducting large surveys in correctional settings and the exclusion of inmates from other major health surveys in the United States (e.g., the National Health Interview Survey) have made national-level comparisons of male and female inmates difficult. To understand and meet the needs of women who interact with the criminal justice system, there is a need for greater knowledge about the relationship between gender and the chronic health characteristics of jail inmates. Management of the wide range of chronic conditions among inmates is particularly important in light of inmates'' increased risk of death after release from incarceration.^20–30 Although many deaths are related to drug use and suicide, there is also an excess risk of death related to cardiovascular disease, liver disease, and other diseases.We examined whether there were gender differences in chronic medical conditions, psychiatric disorders, and drug and alcohol dependence among jail inmates at a national level. Our first aim was to determine whether the prevalence of chronic medical conditions, psychiatric disorders, and drug and alcohol dependence differed between male and female jail inmates after differences in demographic and socioeconomic factors were accounted for. Our second aim was to determine whether gender differences in chronic medical conditions and psychiatric disorders persisted after adjusting for differences in drug and alcohol dependence. Our hypothesis was that female inmates would have a higher prevalence of chronic medical disorders, psychiatric disorders, and substance-dependence disorders than male inmates, even after other demographic and socioeconomic factors had been adjusted for. We further hypothesized that substance dependence would attenuate the differences in medical and psychiatric conditions between men and women in jail.